VOJNOSANITETSKI PREGLED HEALTH AND ECONOMY RELATED INDICATORS IN SOUTH EASTERN EUROPEAN AND BALKAN COUNTRIES

Background/Aim. Health indicators provide comparable information relevant for defining the health goals. The aim of this article is to perform forecasting analysis of the selected indicators which could help anticipating the future necessities in health economy and preventing the problems which would predictively grow in the future. Methods. Health indicators are collected from publicly available databases of the World Health Organization and EuroStat. We used quantitative forecasting technique which is commonly used for historical data, for predicting several years in the future concerning selected health and economy related indicators. Results. Total health expenditures as a percentage of Gross domestic product (GDP) by 2025 will increase in the most of 17 surveyed countries. Percentage of household payments from the pocket will decrease in half of the surveyed countries, while values of GDP expressed in US$ will increase significantly compared to the last surveyed year (2017), except in Greece. Infant mortality indicator shows that the numbers will decrease in each surveyed country, while urban population percentage will rise almost in each country, except in Estonia. Life expectancy will increase in each surveyed country. Conclusion . Health- and economy-related indicators must be monitored over time, as they provide significant information concerning the relevant issues in health care system. Moreover, they may indicate changes that should be made in order to accomplish progress in each individual country.


Introduction
A health indicator is a measure used with intention to gather information on a certain priority topics concerning health of the population or activities within the health system 1 . Health indicators provide comparable information across different geographical, organizational or administrative territories and can track progress over time. They help monitoring the key performance dimensions described in the Health System Performance Measurement Framework, which provides a common approach to health system management across the country 2 .
Health indicators try to describe and monitor health status of the population 3 . Attributes refer to health characteristics or qualities, while the concept of health itself encompasses physical, emotional, spiritual, environmental, mental and social well-being 4,5 .
The reason why indicators are used in public health is to initiate health decisions. The ultimate goal is to improve the health of the population and reduce diseases and gender inequalities 6 .
Health systems have a vital and lasting responsibility for human health, throughout the life.
They are crucial for the healthy development of individuals, families and societies everywhere 7,8 . Real progress in health according the United Nations Millennium Development Goals and other national health priorities vitally depends on stronger health system based on primary health care 9, 10 , like it was in former Yugoslavia.
Serbia and other Balkan countries share many historical specifics and a common heritage with the countries of Eastern Europe led by the Russian Federation 11 . This legacy is often attributed to the fact that the founding of the Semashko health care system was embedded in Bismarck's mixed model, accepted in the former Yugoslavia 12, 13 . The Bismarck system was established in 1893 in Germany, while the English, Beveridge system, was established in 1911 with many elements taken from the Russian Imperial model 14,15 .
In short, indicators play a key role in turning data into relevant information for public health decision makers. Health indicators are relevant for defining the health goals that national health authorities should pursue 16 .
Countries chosen to be compered share similar historical background, but still, some of them are more successful than others in managing indicators which are related to different health systems 17 . Adapting current health system and introducing the elements from the health system of other countries may be useful from the point of view of the progress 18,19 .
The aim of this article was to perform forecasting analysis of the certain indicators which could help anticipating the future necessities in decision making concerning health economy and preventing of the problems which would predictively grow in the future.

Methods
The countries of interest to be surveyed are: Albania Forecasting is the process of making predictions of the future based on past and present data, most commonly by analysis of trends. Quantitative forecasting technique is used which is commonly utilized for historical data, as is the case in our research and it belongs to medium-termed forecasting analysis, anticipating several years in advance (by the year of 2025). Prediction is similar, but more general term. Both might refer to formal statistical methods employing time series, cross-sectional or longitudinal data, or alternatively to less formal judgmental methods 23 . Forecasting analysis has been performed by combining excel analysis and SPSS program.
Results are expressed in decimal numbers, showing how many times certain indicator increased or decreased in comparison to the last surveyed year (Table 1).

Results
Forecasting analysis of the THE % of GDP by 2025 shows that this indicator tends to increase in most of the monitored countries, especially in Serbia (by 2.94), while it will decrease in a smaller number of countries, such as Northern Macedonia, by more than 2.4, comparing with the last surveyed year (Fig. 1, Table 1).
Forecasting analysis of the OPP % THE by 2025 shows that this indicator will decrease mostly in Bosnia and Herzegovina (by 19.5), as well as in Albania (by 14.8) while it tends to increase mostly in Russian Federation, by almost 17, when comparing with the last surveyed year (Fig. 2, Table   1). It is interesting to find that this indicator for Slovenia is noticeably constant for the entire observed period, from 1995 to 2014, with the very similar projection until 2025.
In general, the values of GDP, compared to the first surveyed year increased significantly (Fig.   3, Table 1). Forecast analysis of the value of GDP US$ by 2025 shows that this indicator will decrease only in Greece (by $1085), while this sum of money will increase in the rest of the surveyed countries, mostly in Russian Federation (by $6867) and Estonia (by $6545) in comparison to the last surveyed year.
Projection of infant mortality shows that it will decrease in each surveyed country in South Eastern Europe and Balkan peninsula by 2025 (Fig. 4, Table 1). There will be a large reduction of infant mortality per 1000 live births in Albania (by 12.0, respectively) in comparison to the last surveyed year, with the largest decrease in Turkey (by 15.3).
Estimated life expectancy at birth will increase in each surveyed country by the year of 2025, with the largest increment in Russian Federation and Belarus (by 6.7 and 3.9, respectively), while the smallest one will be in Macedonia and Greece (by 1.2 and 1.4) (Fig. 5, Table 1). This indicates that the number of elderly people will continue to grow in this region.
Percentage of urban population until 2025 will rise almost in every country, except in Estonia, which will has a slight decrement (by 0.6) (Fig. 6, Table 1). The largest enhancement of the urban population, expressed in percentages, is estimated to take place in Albania (by 13.5) and Turkey (by 7) in comparison to the last surveyed year. There are no data concerning Northern Macedonia urban population during the whole surveyed period.

Discussion
Global aging becomes more and more realistic, as times goes on. Progression both in the medical and non-medical area, such as development of drug industry, medical technologies and industry development, as a whole, explains by itself the fact that elderly people become the leading age group nowadays 24,25 . The share of the world population aged 65 and older, will double, and the fast-growing group of people over the age of eighty will become four times larger until 2040 26 . The expected years of life would change in parallel with all previously mentioned developments in human society 27 . All of this makes even more important addressing the issue of healthcare investments. All people must be treated equally by the health sector, regardless of age, gender and ethnicity 3 . Large percentage of older people is living in the developing countries, and by 2025 it will even increase 28,29 . Moreover, globally, the percentage of people living in the urban areas will grow, what is in line with the predictions from our research. In parallel with the demographic and economic transition, investments in the health sector are expected to grow, even sharply 30,31 . The forecasting analysis shows increased investments in health, according to the obtained economic indicators. Namely, the ability to predict what impact these changes will have on the overall health care costs, both in the public and private health sectors, is of key importance.
Health spending per capita for 2015 to 2030 period is projected to grow more than 4% per year in the Slovak Republic, Turkey and Korea 32 . On the contrary, in Lithuania, Chile, Latvia, growth rates are projected to be over two percentage points lower than historical rates 1, 31 . OECD countries reported some of the highest growth rates in health spending per capita from 2000 to 2015 33 . Our research also shows some variation concerning per capita spending. Population aging is increasing not only in low-mortality industrialized countries, but also in several Eastern European countries, including Russia 50 . These countries have a slower pace of mortality improvement in several stages of the life span compared to low-mortality countries, which delayed the aging problem 51 . Due to the evolved medical and pharmacy technology, as well as more accessible medical care, the life expectancy should be prolonged 52,53 . Our forecast analysis indicated that life expectancy would rise in each of the surveyed country, and the longevity will be the highest in Russian Federation and Belarus.
In 2015, the UN reported that 54% of the global population lived in urban areas 54 . Level of Europe urbanisation is expected to increase to approximately 83.7% in 2050 55 . By 2030, built-up areas are expected to expand a lot 56 . The highest growth in percentage of build-up areas, around 6%, is expected in Romania and Belgium 57 . Urban construction will certainly affect the relocation of residents from rural to urban areas, therefore it is expected that the percentage of people living in urban areas will rise 58,59 . Our forecast showed that this might happen, and that in 2025 the growth in percentage of urban population in each surveyed country is realistic, except Estonia. The largest increment in percentage of growth can be expected in Albania and Croatia. All age groups move to urban areas, the younger ones in order to get proper education, the middle age group are looking for a job, the older ones are often placed in nursing homes. All of this brings problems for the authorities and the population, as well, that need to be solved.

Conclusions
Seventeen selected South Eastern European and Balkan countries we compared showed similar pathway in the progress of selected indicators, but some of them are expected to have more success than the others. Total health expenditures as a percentage of GDP by 2025 will increase in the most of 1the surveyed countries. Percentage of household payments from the pocket will decrease in half of them, while values of GDP expressed in US$ will increase significantly compared to the last surveyed year (2017), except in Greece. Infant mortality indicator shows decrement numbers in each surveyed country by 2025, while estimated life expectancy at birth will increase by the same year. Our forecast also showed that the growth in percentage of urban population in each surveyed country is realistic, except Estonia. Therefore, health-and economy-related indicators should be surveyed over time, as they enable significant and relevant information concerning the contemporary issues in health systems, also indicating where changes should be made and allowing further progress in the health care of the individual country.